03D2321692 CLIA NUMBER - NIRVANA RESIDENTIAL TREATMENT

Laboratory Demographics

  • CLIA Code: 03D2321692
  • Facility Name: NIRVANA RESIDENTIAL TREATMENT
  • Facility Address: 15852 N 17TH ST
    PHOENIX, AZ
    ZIP 85022
  • Facility Phone: 602 662-1236
  • Facility Type: Other - RTC
  • Facility Type: Waiver
  • Lab Director: CRAIG W. HEISE
  • NPI Number: 1669289880
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 03D2321692
LAB Type Other - RTC
Facility Name NIRVANA RESIDENTIAL TREATMENT
Street 15852 N 17TH ST
City PHOENIX
State AZ
ZIP 85022
Phone 602 662-1236
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Other - RTC
Lab Director CRAIG W. HEISE

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This page was last updated on: 9/29/2025